Provider Demographics
NPI:1558779272
Name:WOOLEY, BRENDA FAYE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:FAYE
Last Name:WOOLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HAWK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PARON
Mailing Address - State:AR
Mailing Address - Zip Code:72122-9709
Mailing Address - Country:US
Mailing Address - Phone:870-820-7097
Mailing Address - Fax:501-663-2234
Practice Address - Street 1:3358 S 2ND ST STE A-C
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7873
Practice Address - Country:US
Practice Address - Phone:501-286-6053
Practice Address - Fax:501-286-6053
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6461-C101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health